January 11, 2017 Frnt-f-package labelling cnsultatin Health Canada Bureau f Nutritinal Sciences Health Prducts and Fd Branch 251 Sir Frederick Banting Driveway Mail stp 2203E Ottawa, ON K1A 0K9 Via email: Nut.Labelling-Etiquetage@hc-sc.gc.ca T Whm It May Cncern: The Canadian Nutritin Sciety / Sciété canadienne de nutritin (CNS/SCN) is the leading Canadian sciety that integrates disciplines and prfessins interested in fd and nutritin. We prmte fd and nutritin science and educatin, and advcate fr the applicatin f best practice and plicies fr the prmtin f health and the preventin and treatment f disease. The CNS/SCN is pleased t participate in the public cnsultatin prcess n Frnt-f-Package (FOP) labeling. It is ur hpe that the CNS/SCN will cntinue t be called upn t prvide its expertise t Health Canada thrughut its prcess t assist in establishing the mst user-friendly and impactful FOP system that will ultimately assist Health Canada in achieving its bjectives in supprting Canadians t make healthier fd chices that will influence their healthy living. The CNS/SCN has dedicated significant effrt and resurces t put frth the fllwing cmprehensive respnse t Health Canada s FOP labelling cnsultatin. In ding s, we frmed an Expert Wrking Grup cmprised f sme f Canada s leading researchers and stakehlders n this tpic. Members f ur Wrking Grup include: Alisn Duncan, PhD, RD, Department f Human Health and Nutritinal Sciences, University f Guelph / Wrking Grup Chair David Armstrng, MD, FRCPC, FRCP (UK), McMaster University/Hamiltn Health Sciences Sharn By, BSW, CMN, Gerge Brwn Cllege Tristin Brisbis, PhD, PepsiC Mira Cckburn, MSc, Gerge Brwn Cllege Lretta DiFrancesc, PhD, RD, MBA, Surce! Nutritin Marcella Garsetti, PhD, Unilever Canada Mary L Abbe, PhD, Department f Nutritinal Sciences, University f Trnt Christine Lwry, MSc, RD, Healthy Grains Institute Sarah D. Ohlhrst, MS, RD, American Nutritin Sciety (ASN) Maria Ines Pint Sanchez, MD, McMaster University Vernique Prvencher, PhD, RD, Université Laval Dan Ramdath, PhD, Agriculture and Agri-Fd Canada Nathalie Savie, MBA, RD, Dairy Farmers f Canada Pat Vanderky, RD, Public Affairs Manager, Dietitians f Canada Andrea Grantham, Executive Directr, Canadian Nutritin Sciety
Further, the respnse included input frm the CNS Bard f Directrs: Sarah Rbbins, MD, FRCP, CNS President / Gastrenterlgist, Kelwna, BC David Ma, PhD, CNS President Elect and Vice President Research / Assciate Prfessr, Department f Human Health and Nutritinal Sciences, University f Guelph Valerie Marchand, MD, FRCPC, CNS Vice President Clinical / Pediatric Gastrenterlgist, University f Mntreal Rbert Bertl, PhD, CNS Past-President / Canada Research Chair in Human Nutritin and Prfessr, Department f Bichemistry, Memrial University f Newfundland Alisn Duncan, PhD, RD, CNS Treasurer / Prfessr, Human Health and Nutritinal Sciences, University f Guelph Melanie Plurde, PhD, CNS Directr-at-Large / Assistant Prfessr, Université de Sherbrke Vera Mazurak, PhD CNS Directr-at-Large / Assciate Prfessr, University f Alberta Guylaine Ferland, PhD, CNS Directr-at-Large / Prfessr, Université de Mntreal The CNS/SCN is participating as a nn-gvernmental rganizatin. CNS Respnse t the Technical questinnaire n frnt-f-package nutritin labels 1.0. D yu supprt Health Canada's prpsed nutrient-specific "high-in" frnt-fpackage labelling apprach? Please explain. While the CNS/SCN understands and respects Health Canada s intentin and desired bjectives t aid cnsumers in making healthier chices and encurage the refrmulatin f fds t make them healthier the CNS/SCN des nt supprt Health Canada s current prpsed FOP labeling apprach fr the fllwing reasns. This apprach has a lack f evidence and cnsumer testing There is a need fr cnsumer testing t cnsider respnse t this apprach r any ther brader fact-based and interpretive rating FOP systems befre their prpsitin. When the analysis f CCHS 2015 Nutritin cycle data is available, there will be better infrmatin abut dietary intakes and fd cnsumptin patterns indicating nutrients r fd cmpnents t limit r t encurage, r patterns f public health cncern. This infrmatin shuld be used as the basis t cnsider what key advice Canadians need t guide better, healthier fd chices. This apprach is t narrw and will result in a vilificatin f fds rather than supprting Canadians in making healthy fd chices. This apprach is a negative warning based system that des nt include prmtin f the healthy benefits f a fd; further, the fcus n these three nutrients alne is a narrw set f criteria n which t base a decisin t avid a fd r make a relative cmparisn. It ffers n guidance n hw t make a healthy fd chice. T have an influence, dietary guidance shuld be fact-based, and resurces and tls shuld include psitive messaging that ffers guidance n making a healthy fd chice.
This apprach des nt supprt cnsumers t make healthy decisins within different categries f fds, which is what they will be faced with when making purchasing decisins. Lw literate and immigrant cnsumers may find this system challenging, even viewing sme fds as dangerus. The CNS suggests that a cmmitment t public educatin n hw t read the currently available fd labels and understand the cmpsitin and nutritin f packaged fds wuld be a mre valuable investment. Fr the abve reasns, a cmprehensive FOP system is ne that is designed frm infrmatin gathered frm cnsumer testing and prvides bth a fact-based and interpretative rating system. This system can then best help guide cnsumer chice twards healthier fds, rather than simply just a warning system as prpsed by Health Canada. An example f such a FOP system is the Fd Standards Australia New Zealand, which uses a star rating system - a half star t 5 stars (in half-star intervals) - based n nutrients t limit (i.e. saturated fat, sugars, sdium) and nutrients t encurage (e.g. dietary fibre, prtein, vegetable, nuts, legumes). As previusly mentined, cnsumer testing fr the best apprach is mandatry fr an effective FOP system. This apprach may discurage nutritius fds. The system may depict nutritius fds as harmful withut cnsidering the evidence n the fd surces f thse negative nutrients. Using this apprach, cnsumers culd ultimately be discuraged frm chsing mre nutritius fds and nt be discuraged frm selecting fds that are nutrient pr, such as pudding cups, ptat chips and diet sft drinks. If Health Canada wants t encurage the fd industry t refrmulate fds that Canada's Fd Guide recmmends limiting, it shuld ensure that all fds are rated using a system that allws cnsumers t cmpare the healthfulness f fds within a fd categry as nted abve. This apprach may encurage industry t refrmulate prducts t avid being subjected t the FOP criteria. Like the lw fat push several years ag that put the fcus n reducing negative nutrients and replacing it with ther ingredients in rder t fall within the FOP criteria, industry may pt fr similar practices. This includes increased use f highintensity sweeteners with lw nutritinal value ver nutritius fds that cntain added sugar (e.g. flavured milk, ygurt), r remval f lactse frm milk t reduce its natural sugar cntent. Small-serving size items (e.g. seasnings) wuld nt fall under this prpsed FOP labeling criteria due t their small prtin sizes. The prpsed system includes an adjustment t 50 g; hwever, this will lead t incnsistencies with the NFT, which can cause cnsumer cnfusin. HC shuld therefre cnsider a different slutin fr prducts with a small serving size. This prpsed warning system des nt encurage any further healthy refrmulatin f prducts that meet the threshlds. This apprach is incnsistent with ther Health Canada plicies/guidelines and fails t meet/cmplement Health Canada bjectives. With the prpsed fcus n nutrients f public health cncern, the prpsed FOP labelling falls shrt f cntributing t Health Canada s Healthy Eating Strategy,
wherein cnsumptin f minimally prcessed fds will be emphasized (e.g., mre whle grains, fresh vegetables and fruit and legumes). This apprach is incnsistent with sdium targets/benchmarks set by Health Canada fr the varius categries f fds, such as cheese. As acknwledged in the HC cnsultatin backgrund dcument, cnsumers are cnfused abut the healthfulness f fds. FOP labels may add t this cnfusin, as it is nt clear hw the prpsed FOP messages will interface with ther regulated cmpnents f fd labels (i.e. nutrient cntent claims, health claims). A standardized system that is harmnized with ALL regulatry standards/plicies is needed. A cmprehensive FOP system wuld be bth fact-based and interpretive and apply t all fds. 2.1. a) D yu supprt Health Canada's prpsed threshlds fr triggering frnt-fpackage labelling? Yes r n. Please explain. While the use f a 15% threshld has sme merits due t its link with links t the Daily Values (DV), verall the CNS/SCN has cncerns with this apprach. Lack f evidence Mre data is needed n the threshlds that demnstrate its effectiveness in changing eating behaviur. Althugh the prpsed threshlds f 15% f DV are cnsistent with a recmmended verall healthy eating pattern, it may nt be apprpriate t use the same percentage fr every nutrient. Incnsistent within Health Canada s ther plicies Health Canada shuld be striving fr cnsistency within its wn plicies, as well as internatinally respected plicies, such as the WHO. The sdium targets are much lwer than the Health Canada s Sdium Reductin Strategy targets that were established t be reflective f technical and safety issues. This target will be a challenge fr fds that have sdium fr functinal reasns such as leavening, cheese prcessing, and preservatin. Applicatin f the prpsed threshld values is dependent n definitin f serving size and DV which are currently being changed. Additinally, Health Canada thrugh CIHR Best Brains is currently researching sugars and health utcmes as well as ppulatin level appraches that cntribute t reduced cnsumptin f free sugars t generate the evidence t infrm nutritin plicies and prgrams aimed at reducing dietary free sugar cnsumptin. It wuld be mre infrmative fr a FOP system base t use evidence frm this research t create a sugar threshld. Risk f further cnfusin / need fr public educatin Differentiating between threshlds fr servings and prepackaged meals, as well as the different treatment fr fds with small reference amunts will be cnfusing fr cnsumers. This will mean that the infrmatin available n the NFt, with the %DV and the nte (i.e. lw in x, high in x) culd be different than that n the FOP. This apprach des nt ffer meaningful discriminatin within fd categries. In many cases, entire fd categries will be subject t the same warning (e.g. high in sdium ). Cnsumers will nt be able t decipher what chice t make within that fd categry. We cannt assume
that entire fd categries will be rejected. Additinally, there is a risk that cnsumers will ignre the symbls altgether. A cmprehensive educatin campaign that includes establishing understanding hw t read and interpret fd labels and recmmendatins n nutrients f cncern shuld be a high pririty t cmplement any cnsumer tested FOP system. This wuld include infrmatin regarding the 5% vs 15% DVs, which we recgnize that Health Canada has already cmpleted a substantial and excellent educatinal campaign. Pssible industry refrmulatin t fall belw the threshlds This apprach will ffer an incentive t industry t remve healthier ingredients t keep their prduct belw the threshlds with n incentive t add healthier ingredients. The pssible unintended cnsequences may result in manufacturers f flavured ygurt and milk remving lactse ingredients, while maintaining added sugar t meet the ttal sugar threshld; manufacturers f packaged meals, such as pizza and lasagna, may remve cheese ingredients t meet the saturated fat and sdium threshlds. Discuraging nutritius fds This apprach has the ptential f discuraging whle categries f fd that are aligned with healthy eating, such as lwer fat cheeses since they will never meet the saturated fat and sdium threshlds. This can put many whle fds at a disadvantage. The prpsed threshlds d nt accunt fr intrinsic sugars, such as lactse r fructse, and mix them with free sugars. Using this system, many nutrient pr fds may fall belw the threshlds which will send a mixed message when they d nt carry the warning symbl. Fr example, diet sda, chclate pudding, and ptat chips culd be perceived as healthier chices since they d nt have the FOP label. This represents a cmmunicatin challenge fr dietitians, ther fd and nutritin educatrs and healthy eating advcates. b) If yur answer t 2.1a is "n", please suggest alternative threshlds alng with a ratinale and evidence t supprt yur prpsal. The CNS/SCN believes that mre than nutrients f cncern shuld be cnsidered t enable a mre cmprehensive indicatr f nutritinal quality and t assist Canadians in making healthier fd chices using a FOP apprach. In establishing an effective FOP apprach, Health Canada shuld cnsider the fllwing suggestins: Establish a standardized FOP apprach that is harmnized with all Health Canada regulatry plicies t alleviate cnfusin and t assist Canadians in making healthy fd chices. Further, the infrmatin cntained n the FOP shuld be cnsistent with the Nutrient Facts table (NFt) and ffer a % DV fr saturated fat, sdium and sugar building n the Nutritin Facts educatin campaign. Cnsider a hybrid FOP labeling system that cmbines nutrient-specific infrmatin and a summary symbl indicatr based n nutrient threshlds. This summary shuld prvide an verall rating fr cnsumers that wuld be presented in a way that will help a wide range f Canadians easily interpret factual nutritinal infrmatin t help them make infrmed chices. Opt fr a FACT-BASED system that will assist Canadians in making infrmed chices based n infrmatin that includes mre than just nutrients f cncern. Align plicies t be cnsistent with WHO recmmendatins.
2.2. a) D yu supprt Health Canada's prpsed apprach fr fds with small reference amunts? Yes r n. Please explain. The CNS/SCN des nt supprt Health Canada s prpsed apprach fr fds with small reference amunts (RA). RAs are set fr a reasn and their lgic shuld be cnsidered in any FOP system. If adjustments are made, these shuld be cnsistent with ther nutrient claim adjustment appraches r they will create mre cnfusin amng cnsumers, particularly if they differ frm the NFt. Using large prtin sizes fr small RA fds will prmte miscnceptins and will nt match typical eating patterns f these fds. b) If yur answer t 2.2a is "n", please suggest an alternative apprach alng with a ratinale and evidence t supprt yur prpsal. The FOP apprach shuld be based n a standard reference amunt t enable a level playing field amng fds f varying serving size. The CNS/SCN believes that the FOP shuld be a tl that wrks alng with the rest f the nutritin labelling n a prduct. This supprts the lgic that if a fd prduct has a NFt then it shuld be subjected t the FOP system. Cnversely, if the fd prduct des nt have a NFt, then it shuld nt be subjected t the FOP system. The cncept f healthy ils needs t be recnsidered as it culd be miscnstrued t mean that cnsumptin des nt need t be mderate. Manufacturers will have the ptin f nutrient cntent claims t highlight the healthfulness f their ils. 2.3. a) D yu supprt Health Canada's prpsed apprach t exempt fds frm frntf-package labelling if the current Fd and Drug Regulatins d nt require the fd t carry a Nutritin Facts table? Please explain. While there is merit t this apprach in that it is cnsistent with the NFt regulatins, f which FOP is an extensin f, this is an area that CNS/SCN wishes t express cautin. There are already a number f exemptins t nutritin labelling that are nt justified frm a public health nutritin perspective, and where the fd is quite standardized r cmes frm a central supplier. These fds (e.g. grcery stre take-away fds, in-stre bakery prducts) shuld nt be exempt frm nutritin labelling r FOP systems. Additinally, there is an emerging trend in which snack fds r fds in small packages are being prmted as easy and cnvenient. These types f fd items ften cntain nutrients f cncern. Therefre, exemptin f fd prducts with very small packages (e.g. bite-size chclate bars) as utlined is ptentially an unregulated surce f unhealthy calries. Cnsumers shuld be made aware f this risk. The mre the FOP is cnsistently applied t all prcessed and packaged fds, the mre this issue will be reslved. As such, nly when larger packaging is nt available fr cnsumers directly wuld this exemptin be apprpriate. b) D yu supprt Health Canada's prpsal t exempt packages f sugar and salt frm frnt-f-package labelling? Please explain. Given that cnsumers are expsed t small packages f sugar and salt withut their larger package (e.g. fd service) and their use is rutinely minr, it is lgical that they wuld be exempt frm FOP labelling. As mentined abve, if a fd prduct des nt have a NFt then it can be exempt frm the
FOP system, as the cnsumer wuld have n ther infrmatin n the label t g alng with the FOP label. 3.0 a) D yu supprt Health Canada's apprach t chsing a frnt-f-package symbl fr fds high in sdium, sugars and saturated fat? Please explain. While the CNS/SCN is in full supprt f the need fr a strategy and a prgram that will assist Canadians in making infrmed healthy fd chices, it des nt supprt Health Canada s FOP symbl apprach as presented. The prpsed apprach suggests a negative interpretative symbl/warning system that depicts fds as harmful and des nt accunt fr the fd surce f varius nutrients. This apprach will nt ffer easy-t-use infrmatin t help cnsumers quickly determine if a fd is a healthier chice and will nt enable easy cmparisn f fds within a fd categry. Ultimately this will lead t mre cnfusin amng cnsumers in terms f what is cnsidered a nutritius, healthy fd. b) Which symbl shwn in Figure 1 belw wuld best help infrm Canadians abut fds high in sdium, sugars and saturated fat? Please explain. Fr the reasns stated abve, the CNS/SCN des nt supprt any f the suggested symbls. They all lk like warning symbls and will discurage cnsumers even thugh there are ther psitive nutritinal elements in the fd. Nne f these suggested symbls will help cnsumers t chse fds t cntribute tward a healthy diet and, in many cases, can be misleading. c) If yu d nt agree that any f the symbls in Figure 1 wuld help infrm Canadians, please prpse an alternative symbl alng with a ratinale. The CNS/SCN urges Health Canada t establish a FOP system that addresses mre than just nutrients f cncern t enable a mre hlistic apprach t fd chices. Further, the CNS/SCN recmmends that Health Canada cnduct cnsumer fcus grups and cnsumer research t establish a symbl system that is evidence-based in its ease fr all cnsumers t understand. 4.0 a) D yu supprt the changes prpsed t update claims and ther nutritinrelated statements described in Table 3? Please explain. N, the CNS/SCN des nt supprt the changes prpsed t update claims and ther nutritinrelated statements as presented. We believe that these revisins must be cnsidered in tandem with the regulatry revisins t nutritin labeling that were recently published. Further, additinal cnsumer research is needed t ensure that cnsumers are nt cnfused by the prpsed changes. b) If yu d nt supprt ne r mre f the prpsed changes, please identify the subject f the prpsed change (e.g., "i. n added sugar" claim) and explain why, alng with a ratinale and evidence t supprt yur cmments. i. N added sugars / ii. Unsweetened The CNS/SCN is nt in agreement with the Health Canada s prpsitin t nt permit the N added sugars r unsweetened claim fr 100% fruit juice. These are nutrient-dense fds that,
if cnsumed in the recmmended serving sizes can be a part f a healthy diet. In additin, sme cnsumers may believe that free f sugars is the same as free f sweeteners, which is nt accurate. It is nt clear if/hw artificial sweeteners will be acknwledged thrugh this FOP labeling system. If this is nt clearly stated, it may be misleading t cnsumers wh may think free f sugars is the same f free f sweeteners. It des make sense t align the meaning f added sugars with the new definitin f sugarsbased ingredients iv. Lw in sugars / v. Lightly Sweetened The CNS/SCN cautins against the new claims fr lw in sugars and lightly sweetened since it may cause refrmulatin f prducts that d nt encurage healthy eating r may cause an increase in prducts that have lw nutrient density but qualify fr these claims, fr example due t the use f high-intensity sweeteners. Cnsumers may be swayed t chse fds that cntain high-intensity sweeteners with a lw nutritinal value (e.g. pudding cups with n added sugar r diet sdas) ver nutritius fds that cntribute essential nutrients but cntain added sugars, such as flavured ygurt. The lightly sweetened claim fr fds that have at least 50% less sugars-based ingredients than the similar fd that is nt lw in sugars is misleading since it des nt represent hw much sugar is in the lightly sweetened fd. In current cases, many f these fds are nt lw in the respective nutrient. This claim shuld therefre nly be in place if the fd is currently lw in sugars, therwise it is misleading and cnfusing fr the cnsumer. The prpsed lightly sweetened claim may cause cnfusin since sme refrmulated fds (i.e. chclate milk, flavured ygurt, fruit spreads) culd bear this claim while having the high in sugar FOP label. Thus, the messages delivered thrugh this claim and the FOP label wuld nt be cnsistent. vii. Lean Claim The term lean is cnfusing and des nt have a clear definitin. Prducts shuld be allwed t carry the lean claim withut meeting the regulated definitin f prepackaged meal if they are represented fr use in a weight maintenance diet. 5.0 a) D yu supprt the changes prpsed t eliminate the requirements fr the principal display panel declaratin and the quantitative declaratin n fds cntaining sucralse, acesulfame-ptassium and netame? Yes r n. Please explain. CNS/SCN believes that this issue wuld be best addressed thrugh fcus grups with individuals wh have phenylketnuria (PKU), care fr smene with PKU, and prvide dietetic advice t thse with PKU, t determine if this prpsed eliminatin will be harmful t the PKU cmmunity. With this in mind, CNS/SCN acknwledges that these ingredients are already listed in the ingredient list and that thse individuals with PKU wuld be n alert and be reading the ingredient list. Furthermre, this apprach is in line with the United States regulatins. We als acknwledge that n ther additives are listed in such a way n the FOP. b) If yur answer t 5a. is "n", please prvide yur recmmended apprach alng with a ratinale and evidence t supprt yur prpsal.
Nt applicable. c) If yu are smene wh either has phenylketnuria (PKU), cares fr smene with PKU, r prvides dietetic advice t thse with PKU, what are yur views cncerning the principal display panel and quantitative declaratin labelling requirements fr aspartame? An FOP warning n the cntent f specific nutrients will help peple with their dietary chices. As with cnsumers wh have fd allergies, we wuld expect that cnsumers wh have a knwn metablic cnditin (such as PKU) wuld spend mre time in reading labels carefully t identify whether the fd cntains a nutrient f cncern. The CNS/SCN hpes that ur respnse t the public cnsultatin prcess n FOP labelling n fds prvides feedback f value. We recgnize the challenge f placing a nutritinal value n a fd rather than a diet, and that this is an inherent limitatin f any FOP system. Regardless, we hpe ur feedback will help Health Canada advance cnsideratin f a FOP system that will best meet Canadians need fr guidance in making healthy dietary chices. T help the advancement f this imprtant prcess, we encurage Health Canada t fully engage the expertise f the CNS/SCN and ther stakehlders, including cnsumer scientists, at all stages f this initiative. Please d nt hesitate t cntact us fr further infrmatin r clarificatin. Sincerely, Alisn Duncan, PhD, RD CNS FOP labelling Wrking Grup Chair Andrea Grantham CNS Executive Directr